Clinical Profile of Adults with Long-Standing Type 1 Diabetes: A 30-year-Experience from Theptarin Hospital, Thailand

Authors

  • Thewjitcharoen Yotsapon Theptarin Hospital
  • Krittiyawong Sirinate
  • Porramatikul Sriurai
  • Anuntakulnatee Tawee
  • Kittipoom Worawit
  • Vongterapak Somboon
  • Nakasatien Soontaree
  • Himathongkam Thep

Abstract

Objective. To present our 30-year experience with type 1 diabetes in adults treated at Theptarin hospital, Bangkok, Thailand.

Methodology. A retrospective study was conducted on medical records of patients with type 1 diabetes in Theptarin hospital between 1983 and 2013. Clinical characteristics, glycemic control, and complications were retrieved and compared between patients who developed complications and those who have remained free of complications.

Results. There were 129 T1DM patients who attended our hospital during the three decades. Two patients died from sepsis and leukemia. Only 70 patients are still active on follow-up (median time of follow-up 11.1 years, range 0.3-29.2 years). In the active follow-up cohort,  the  mean age of onset was 25.3(12.4) years and duration of diabetes was 14.4(10.0) years. The  mean HbA1c and LDL were 7.9(1.4%) and 99(30) mg/dl respectively. Optimal glycemic control (HbA1c ≤ 7%), LDL control (LDL≤ 100 mg/dl), and target blood pressure (BP ≤ 130/80 mmHg) were achieved in 31%, 54%, and 97% of patients respectively. The optimal combined target values for glucose, LDL, and blood pressure were achieved in only 17% of patients. The cumulative incidence of retinopathy, nephropathy, and cardiovascular disease were 17%, 19%, and 0.4%, respectively. Only longer duration of diabetes was associated with increased risk of development of microvascular complications.

Conclusions. Despite advancement in the treatment of diabetes, optimal glycemic control has not been achieved in most adult patients with T1DM. Microvascular complications have been observed in about one fifth of patients. Intensive therapy should be implemented as early as possible in order to ameliorate long-term complications of diabetes

Downloads

Download data is not yet available.

References

International Diabetes Federation. Diabetes Atlas. 6th ed. Brussels, Belgium, International Diabetes Federation, 2013.

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329: 977–86. http://dx.doi.org/10.1056/NEJM199309303291401.

Tuchinda C, Likitmaskul S, Unachak K, Panamonta O, Patarakijavanich N, Chetthakul T. The epidemiology of type 1 diabetes in Thai children. J Med Assoc Thai. 2002; 85: 648–52.

Panamonta O, Thamjaroen J, Panamonta M, Panamonta N, Suesirisawat C. The rising incidence of type 1 diabetes in the northeastern part of Thailand. J Med Assoc Thai 2011; 94:1447–50.

Livingstone SJ, Looker HC, Hothersall EJ, Wild SH, Lindsay RS, Chalmers J, et al. Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study. PLoS Med. 2012; 9: e1001321.

Harris MI, Robbins DC. Prevalence of adult-onset IDDM in the US population. Diabetes Care. 1994;17:1337-40. http://dx.doi.org/ 10.2337/diacare.17.11.1337.

Palmer JP, Hirsch IB. What's in a name: Latent autoimmune diabetes in adults, type 1.5, adult-onset, and type 1 diabetes? Diabetes Care. 2003;26:536–8. http://dx.doi.org/10.2337/ diacare.26.2.536.

Fourlanos S, Dotta F, Greenbaum CJ, Palmer JP, Rolandsson O, Colman PG, et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia. 2005;48:2206–12. http://dx.doi.org/10.1007/s00125-005-1960-7.

Hampe CS, Kockum I, Landin-Olsson M, Törn C, Ortqvist E, Persson B, et al. GAD65 antibody epitope patterns of patients with Type 1.5 differ from that of type 1 diabetes patients. Diabetes Care. 2002;25:1481–1482. http://dx.doi.org/10.2337/ diacare.25.8.1481.

Hillman M, Torn C, Thorgeirsson H, Landin-Olsson M.IgG4-subclass of glutamic acid decarboxylase antibody is more frequent in latent autoimmune diabetes in adults than in type 1 diabetes. Diabetologia. 2004;47:1984–9. http://dx.doi.org/ 10.1007/s00125-004-1558-5.

Karjalainen J, Salmela P, Ilonen J, Surcel HM, Knip M. A comparison of childhood and adult type 1 diabetes mellitus. N Engl J Med. 1989; 320:881-6. http://dx.doi.org/10.1056/NEJM 198904063201401.

Beck RW, Tamborlane WV, Bergenstal RM, Miller KM, DuBose SN, Hall CA. T1D Exchange Clinic Network. The T1D Exchange clinic registry. J Clin Endocrinol Metab. 2012; 97: 4383–9.

http://dx.doi.org/10.1210/jc.2012-1561.

Scottish Study Group for the Care of the Young. Factors influencing glycemic control in young people with type 1 diabetes in Scotland: A population-based study (DIABAUD2). Diabetes Care. 2001;24:239–244.

Glasgow RE, Hampson SE, Strycker LA, Ruggiero L. Personal- model beliefs and social environmental barriers related to diabetes self-management. Diabetes Care. 1997;20:556–561.

http://dx.doi.org/10.2337/diacare.20.4.556.

M Schutt, EM Fach, J Seufert, W Kerner, W Lang, A Zeyfang, et al. Multiple complications and frequent severe hypoglycemia in 'elderly' and 'old' patients with Type 1 diabetes. Diabet Med. 2012;29:e176–9.

Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin epidemiologic study of diabetic retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology. 1998;105:1801–15. http://dx.doi.org/10.1016/S0161-6420(98)91020-X.

Cooper ME. Pathogenesis, prevention, and treatment of diabetic nephropathy. Lancet. 1998;352:213–219. http://dx.doi.org/ 10.1016/S0140-6736(98)01346-4.

Panamonta N, Prathipanawatr T, Panamonta O. Factors influencing chronic diabetic complications in type 1 diabetes. Southeast Asian J Trop Med Public Health. 2012; 43: 1245-51.

Kilpatrick ES, Rigby AS, Atkin SL. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: "Double diabetes" in the Diabetes Control and Complications Trial. Diabetes Care. 2007;30:707-12. http://dx.doi.org/10.2337/ dc06-1982.

McGill M, Molyneaux L, Twigg SM, Yue DK. The metabolic syndrome in type 1 diabetes: Does it exist and does it matter? J Diabetes Complications. 2008;22:18-23.

Kordonouri O, Klinghammer A, Lang EB, Gruters-Kieslich A, Grabert M, Holl RW. Thyroid autoimmunity in children and adolescents with type 1 diabetes: A multicenter survey. Diabetes Care. 2002;25:1346-50.http://dx.doi.org/10.2337/ diacare.25.8.1346.

Downloads

Published

2014-11-29

How to Cite

Yotsapon, T., Sirinate, K., Sriurai, P., Tawee, A., Worawit, K., Somboon, V., … Thep, H. (2014). Clinical Profile of Adults with Long-Standing Type 1 Diabetes: A 30-year-Experience from Theptarin Hospital, Thailand. Journal of the ASEAN Federation of Endocrine Societies, 29(2), 152. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/134

Issue

Vol. 29 No. 2 (2014): November Issue

Section

Original Articles

License

Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).

To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.

A written agreement shall be emailed to the requester should permission be granted.

Most read articles by the same author(s)